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72 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # )ZScO —oJV <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Make this a "W" Permit ❑ SRC Required (Pre-Insp) <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />t <br />Occupancy Group-L <br />Occupancy Load <br />Cert. of Occpuancy Required? <br />❑No ®Yes ❑Shell Only <br />Code Year <br />02021 /Q2018 ❑2015 <br />Fire Sprinklers: ❑Update Existing ❑New System QNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System QNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add'I RCW 64.55 docs required priorto final? ❑Yes ©No <br />VALUATION CALCULATION: Total $ i 6 �'1� sz- 1, <br />Additional Notes: <br />Approved By: Date: 3 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: <br />Date: 'I - <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />Zone <br />Overlay/Agreement <br />'IVA <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? AYes []No <br />"In Lieu" Fee: Type: — Amount $ <br />School Impact Fee: Total $ / — <br />Calculated: // Z1Credit: -0- <br />❑Everett School Dist BMukilteo School Dist <br />Park Impact Fees for permits applied for after 1/112022: <br />Park Impact Fee Total $ 0 - (net due after credit for existing uses) <br />Fee Schedule Used For Calculation (Year): d(21 3 <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: i <br />1 PWReview &-WorksheetNeeded if: <br />❑Sys Dev Eva] <br />❑Water ❑Sewer ❑Storm <br />!(❑Traffic Mitigation Eval <br />ID Site Work/Drainage (shown/triggered) <br />❑Address Letter <br />❑Backflow Prevention for high hazard: <br />!(dental, medical, animals, mortuary, <br />!hospital, supportive housing) <br />I <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is fully digital <br />❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor permit issuance) <br />❑ WIII be issued separately (Separate Green Folder, Pw issued ahead of Bldg) <br />❑ Public Works has no scope on this permit --- PW Not Required <br />Additional Notes: <br />Completed By: Date: I / L <br />